PRE2023 3 Group7
Pill dispensing robot
Team and interests
Quinten Liu, 1842471, q.m.liu@student.tue.nl
Fenna Sigmond, 1696947, f.e.sigmond@student.tue.nl
Thijs Frints, 1441523, t.g.g.frints@student.tue.nl
Daniel Joaquim Ho, 1534254, d.joaquim.ho@student.tue.nl
Sven de Gruyter, 1857657, s.d.gruyter@student.tue.nl Sjoerd van de Goor, 1557815, s.v.d.goor@student.tue.nl
Interests:
- Medical Imaging
- Physical product
- AI
- Tangible / functional product
- Danger detection or prevention
- Healthcare or elderly care
Meetings
Target Audience
People that are taking medication long term and have trouble taking and managing their medication. This target audience could be expanded depending on the outcome of the interviews.
Stakeholders and their interests
To identify the problem statement certain stakeholders and their interests in the pill dispensing robot are identified using literature (and interviews).
Patient
Patients can have trouble taking medication on the right time and are insecure about their management of their medication. The pill dispensing robot can help them increase their medication adherence, by making a planning for them for taking the medication on the right time, getting notifications on when to take medications, instructions for taking their medications, and answering questions they might have.
Informal caregivers
The caregivers that help the elderly managing their medication are not always present to answer questions and do not always know if the medications are taken the right way and at the right time. The pill dispensing robot can help their administration so they can assist the elderly people. Also if they are not around, the robot can answer questions instead of them.
General practitioner
The robot could help the GP get better insight in the medical administration.
Users
- Patients
- The people using the device, this can be an elderly person, or a person who is forgetful. They are the primary users of the device, interacting most with it.
- Care Givers
- The informal caregivers are also users as they are the ones that will likely setup the device, and potentially monitor the patient via the device.
Society
- Government
- They are responsible for setting the regulations and discussing the ethics
- Care givers/GP
- The remote monitoring could help the care givers that do not interact with the patient on a day-to-day basis a better insight on the situation of the patient.
Enterprise
- Companies
- Companies that develop the product need to keep the users in mind.
- Hospitals/pharmacies
- For pre-filled storage modules, the best implementation is to have partnered hospitals and pharmacies which can package the prescription directly into a storage module that can be inserted into the machine.
Ethical Aspects
Product Overview
A robot which dispenses pills on a specific schedule and can inform about and answer questions about medical usage, which may be interacted with by speech, and buttons, and which talks back and provides subtitles on the spoken texts using a screen.
Preliminary Functional Requirements
Software
- AI integration to understand speech
- AI integration to process natural language inquiries about medicine in the specific context of the patient
- AI integration to process natural language outputs to spoken language
- Software to memorize and on time inform about medicine intake
- Remember which medicine was taken
- Admin-client distinguishment in access to schedule
Hardware
- Easily swappable medicine cartridges for about 4 types of medicine
- Dispensing function
- Speaker, screen, microphone, buttons
- Small and light
- Probably stationary
- Non-intrusive
Informal planning
| Week 1 | Week 2 | Week 3 | Week 4 | ||||
|---|---|---|---|---|---|---|---|
| Literature review + summaries
Relevant groups’ work |
A
|
Literature discussion
Functional requirements Target audience & problem |
A | Designing
Preliminary software Components + feedback + order needed |
Finalize components
Software prototype 3D modelling of product |
||
| Week 5 | Week 6 | Week 7 | Week 8 | ||||
| Software done
Assembly done 3D Printing done |
Iterate on software or add app
Solve problems |
Solve problems
Prepare presentation Begin cleaning up wiki |
Present
Clean up wiki |
||||
A = All, Q = Quinten, F = Fenna, T = Thijs, D = Daniel, Sv = Sven, Sj = Sjoerd
State of the Art
Available Products on the Market
When it comes to the state of the art of medicine dispensing, there are currently two types of solutions: passive and active. The passive solutions are the standard pill boxes that allow the patient to sort the medication into smaller compartments based on which day the medication needs to be taken. Active solutions are the autonomous solutions that dispense meddication, notify the patient, and even notify the caregiver when medication should be taken. This project aims to implement an active medication solution.
The passive solution comes in a variety of options, usually being a plastic container with sub-compartments for the storage of medication. These are the more traditional pill boxes, where the user needs to sort the medication beforehand into the correct sub-compartments. This type of solution tends to only hold enough medication for a week, requiring the containers be refilled and medication sorted every week by the user, where human error could play a role. This solution does not include any form or reminders, rather a container of all the medication that should be taken at a specific time. This still requires the user to remember to take the medication.
The alternative is an active device, of which there are two alternatives: DoseControl and the Hero Smart Dispenser. The first device, DoseControl, is a radial pill box that can remind the user to take their medication. The medication still needs to be sorted into their respective compartments, and the time of medication intake set. However, once that is done, the device will rotate the medication compartments such that the next compartment is aligned with the dispensing hole. The device then rings like an alarm clock, and can send a notification via the app if it is set up on the user or care givers phones. This is already an improvement to the pill boxes, but still requires the periodic refilling and organizing of the medication into the compartments. This device also does not have a form of confirmation that the medication has been taken from the device. This is a relatively affordable device, currently available in the EU. Similar devices from other companies are also available.
The Hero Smart Dispenser is a device that has 10 compartments for medication, meaning that it can store up to 90 days worth of 10 different medications. This device is setup to play an alarm noise when it is time to take medication, and dispense the medication according to the prescription. The device is also connected to an app, and both the caregivers and patients can receive notifications when it is time to take medication. The Hero dispenser also has a button on it, which the patient has to press in order for the medication to be dispensed. This also allows for a second notification to the caretaker informing them that the patient has taken the medication from the machine. The app that comes with this device tracks data such as dosages taken, missed, and when medication was taken. This dispenser makes it quite easy for the users to refill the medication, and easy for the caregivers to remotely check on the adherance of the patient. This device is only available in the US, with similar products also being available in the US. There is currently no equivalent in the EU. This device is available on a subscription basis, directly from Hero.
This project aims to create an active solution, similar to that of the Hero dispenser, with an application such that notifications, dosages, intake, and medicinal information can be given. The aim is to have the device be prescribed to patients via hospitals for long-term medicine intake in order to aid the patient and informal care givers.
Medical Adherance
The problem we are trying to address with our product is a lack of medical adherence, predominantly because of forgetfulness. While it’s important to justify the design choices of the product, consulting existing literature and state-of-the-art products in this domain will accelerate the project's development by using existing knowledge.
Effectiveness
One very crucial question to ask is how effective this type of technology has been in addressing medication adherence. In fact, Low-cost reminder devices like pillboxes, pill bottle toggles and cap timers do not improve adherence in nonadherent patients, as found in a 50.000 patient data review by Niteesh et al in 2017. Unfortunately, this is the technology most used by people and the easiest to find on the market at the moment. Meanwhile, electrical medical adherence products (MAPs) are not very popular among patients. a review of many peer-reviewed studies testing the effectiveness of electrical MAPs assessed whether MAPs improve adherence and identifies and describes common features of electrical MAP devices. The conclusion was made with the data of 37 qualifying studies with a sample size of 4326 patients. The conclusion is that MAPs have a definite ability to improve adherence by up to 49%. And more specifically, devices that were integrated into the care delivery system and that were designed to record dosing events were most associated with improved adherence.
MAPs also all had 5 common characteristics overall:
- recording dosing events and storing a record of adherence
- audiovisual reminders to cue dosing
- digital displays
- real-time monitoring
- providing patients with adherence performance feedback
Thus it can be concluded that the development and use of MAPs is by all means very relevant as they greatly improve the medication adherence of patients in general, even though they are not commonly used, while low-cost common medication adherence devices seemingly do not improve this statistic at all. Integrated delivery systems and recording dosing events are features that improve adherence the most.
[I'm not done I'm still adding stuff]
Goals of review:
- Find state of the art
- Find what was done; what worked, what did not work. Perhaps reach out to the members of groups of previous years to ask for further details
- Medical technology state
- Pill dispensing specifics
- Elderly technology interaction
- Privacy and ethics of the technology
Literature Review of already existing medicine dispensers
Existing Products, Specifications, and Research and Regulation
General Literature Review of comparisons, effectiveness, and ethics regarding MAPs
Interview preparation
Patient
- Would you prefer to have this device be portable? Why or why not? (Stationary/portable)
- How do you take your medication on holiday or days out?
- Do you want to be able to take medication with you while on holiday? (Ability to take doses away from home)
- Do you prefer physical buttons or touchscreen to interact with the device? (Buttons/touchscreen)
- How many different medications should the machine hold? (Amount of different pills)
- How often do you get more medication from the pharmacy? (Storage capacity)
- How would you like to be notified to take medication? What notification method works best for you? (Notification)
- When the medicine is ready, the machine plays a noise and produce a light signal. It will also send a phone notification after 5 minutes if not taken. Would this be a nice way to be reminded?
- Would you prefer to fill the machine with pre-packaged rolls or pills from a bottle? (refill)
- How do you currently get your information about your medication? How would you like to receive information about your medication? (Information)
- What are suggestions for the device that would make it better to use? (General/ending)
Caregiver
- How does responsibility surrounding medicine intake currently work?
- Do you check that the patient has taken their medication?
- What would you like to be notified about? (Amount of monitoring/ validation)
- How do you want to be notified that the patient has to take/ has taken the medicine? (Notification)
- Would you prefer to fill the machine with pre-packaged rolls or pills from a bottle? (How to refill)
- What is the current protocol for medicine intake? Which aspects should the device do? (Security)
- What are suggestions for the device that would make it better to use? (General/ending)
Old Interview Questions From minutes
- How often do you forget to take your medicine a week?
- How do you currently store your medicine?
- How do you currently get the information about your medication?
- Are you away from home a lot for longer periods and therefore have to take your medication storage with you?
- Do you want to have more information with taking your medication, so for example, let you know that you need water with a specific pill?
- Do you want help with taking your medication?
- What would help you with taking your medication on time?
- Do you currently have problems with taking your medication?
- How do you spend most of your days, are you at home a lot?
- How do you get more medication currently?
- What do you still miss from the description of our proposed design?
Translated old questions for interviews
- Hoe vaak worden medicijnen vergeten door patiënten? En als dat vaak gebeurd, wat is dan de oorzaak?
- Hoe komt de medicatie terecht bij de patiënten? (bijvoorbeeld via mantelzorgers of halen ze die zelf op)
- Hoe komen de patiënten informatie over de medicijnen te weten?
- Komen er problemen voor bij het nemen van medicatie, en wat is hiervan de oorzaak? (bijvoorbeeld bij onduidelijke instructies,( pil nemen met glas water bijvoorbeeld.)
- Hoe en waar wordt de medicatie opgeborgen/bewaard?
- Als patiënten weg zijn van huis, hoe zorgen ze ervoor dat de medicatie op tijd en op een juiste manier wordt genomen? (voor een korte periode, zoals een dagtrip of bezoek, en voor een langere periode van huis)
- Is er behoefte aan een manier om medicatie op een overzichtelijkere/betere manier mee te nemen als patiënten van huis gaan?
(After a brief description of our design idea)
- Zou deze robot patiënten kunnen helpen met het nemen van medicatie op tijd en op de juiste manier?
- Zou deze robot patiënten en mantelzorgers kunnen helpen met de administratie van de medicijnen?
- Zijn er nog andere functies die handig zouden zijn voor een robot als deze?
Privacy Research
- A patient can give their permission to use personal data, if they have received all the relevant information about the possible consequences and the reasons for data sharing.
- Assumption of patient’s permission to share information
- In the case that no Personally identifiable information (PII) is used, data can be shared
https://www.knmg.nl/actueel/dossiers/beroepsgeheim/medisch-dossier
- Caregivers that need access to information to care have permission
- Professional secrecy can expire for scientific research purposes
- Caregivers can share information that is directly relevant to their work
https://www.regelhulp.nl/onderwerpen/kwaliteit/beroepsgeheim
- Organizations outside of healthcare can obtain health data but must fulfill the confidentiality obligations
https://www.autoriteitpersoonsgegevens.nl/themas/gezondheid/gezondheidsgegevens-gebruiken-en-delen/gezondheidsgegevens-delen-met-derden#algemene-regels-gegevens-delen
For robot/app:
Compartmentalization of data can be done to avoid the necessary use of private data. The robot would have no access to PII and only to relevant information; the type of medication and doses. The caregiver or doctor connected with the robot would have that information and for example: connect the medical dossier to a number that would be shared with the robot. The only viewer of personal data would be the doctor/caregiver, already having the patients permission.
Norm for data security in healthcare called NEN 7510, publicly available in the Netherlands
- Data can only be given and used when:
o Caregiver needs to carry out an activity for which data is needed
o There exists a healthcare relation between person and patient to which the data is connected to
o Data is needed in support of an activity
https://www.nen.nl/zorg-welzijn/ict-in-de-zorg/informatiebeveiliging-in-de-zorg
For interview/survey:
- Caregivers can give information not pertaining to a specific patient as long as no PII is given
- With permission of the patient, caregivers can give more in-depth information (since our research does not pertain to the patient themselves it is most likely not necessary)
Time spent
Week 1:
| All | 1st meeting (2h) |
| Quinten | Researching SotA (2h); Finding and reading relevant papers regarding medication dispensers (3h); Finding and reading relevant papers regarding ethics and elderly care (2h) |
| Fenna | Research State of the Art (1h); Robot specifications (2h); Research Product Design (1h); Research Use Case (2h) |
| Thijs | Looking at already functioning medicine dispensers (1.5h); Reading papers on dispensing robots and summarizing them (4.5h); look at ethics for medication rules (0.5) |
| Daniel | Research what has been done/state of the art (3.5hr); Dispensing Specifications (1.5hrs); EU regulations, medical technology state, privacy and ethics of the tech (3.5hr); |
| Sven | Research on state of the art/dispenser mechanisms (1,5h); Research AI implementation by notifications (1,5h), naming requirements/specifications (1h) |
| Sjoerd | Setup wiki (2h); process annotations of first meeting (1.5h); Read documentation OpenAI and Google for insight into which we can use (3h) |
Week 2:
| All | Feedback Monday meeting and evaluation (1h), Meeting 23-2-24 (1h) see minutes |
| Quinten | Transfer and ordering of data to wiki (1h) |
| Fenna | Privacy Research (1.5h) |
| Thijs | |
| Daniel | Identifying Stakeholders (1h), Interview Questions (2h), Data requirements (0.5h) |
| Sven | start identifying stakeholders and specifying the target audience (1,5h), translate and improve interview (1h) |
| Sjoerd | Create prototype AI implementation, with testing and prompt engineering, using API documentation (4h) |
Week 3:
| All | Feedback Monday meeting and evaluation (1h) |
| Quinten | |
| Fenna | |
| Thijs | |
| Daniel | Cleaning up Interview Questions (1h); Incorporating Literature Review into Wiki (2h); |
| Sven | |
| Sjoerd |